Basic Mechanism of Parasitic Diseases

The Nature of Disease

• Pathogenic Organisms
• Genetic Disorders
• Toxic Chemicals
• Other Environmental Factors
• Physical Damage to Organs
• Nutritional Disorders
Types of Pathogenic Organisms
• Viruses
• Bacteria
• Protozoan (Unicellular Parasite)
• Fungi
• Animal
• Parasites
Parasites

Protozoa
Metazoa: Helminths
Arthropoda

Pathomechanism:
Interaction between the parasites with the human
Hosts and its part(s) thereof
 Lecture objectives

To understand basic principles of diseases caused

by parasite infections:

parasites
- protozoa
- helmints
-Arthropodes
 Parasites
- complex eukaryotic organisms

- most common infectious diseases (30% of world population)

- complex life cycles
- protozoa (unicellular)
- helmints (multicellular warms)

- often induce chronic infections

- constant exposure (endemic areas)
- direct exposure or via vectors
 Diversity of Human-Microbe-
Relationships
Immediately after birth: humans are colonized by a
myriad of microorganisms

The human body as a “superorganism”: microbes

outnumber human cells by tenfold !

• Commensal relationships

• Mutualistic relationships

• Microbes as pathogens
 Parasitic Diseases

• Protozoan and helminthic parasites exist worldwide

• Common among people in rural, undeveloped, or
overcrowded places
• Emerging as serious threats in developed nations
• Parasitic infections often involve several hosts
– Definitive host
– Intermediate host
• Parasites can infect humans in several ways
Routes by which humans acquire
parasitic infections
 Pathomechanisms of host defense
against infection by parasites
Injurious effect of immune response
- granuloma formation and fibrosis (Schistosoma sp.)

- immune complex formation (Plasmodium sp.)

Mechanisms of immune evasion

- existence of different forms/stages (Plasmodium sp...)

- alteration of surface antigens (Trypanosoma sp....)

- complement resistance (many parasites)

-“concealing” – cysts (Toxoplasma sp.), residence in gut (intestinal parasites)

 Common Clinical Presentations of Parasitic
Infections

 Hepatosplenomegaly • Parasites causing this

clinical presentation
 Enlarged lymph nodes
• How did the parasite
 Anaemia produce this presentation
(Pathogenesis)
 Diarrhea/ dysentery • Mode of infection
A child presenting with hepatosplenomegaly
Helminths causing hepatosplenomegaly:
Schistosoma Skin penetration by
Furcocercous cercaria

HOW?
Schistosoma eggs that pass in the circulation as
emboli to the liver cause hepatosplenomegaly
 A child presenting with hepatosplenomegaly
Protozoa causing hepatosplenomegaly:
Leishmania infantum,
Leishmania donovani,
Leishmania chagasi
Visceral leishmaniasis Promastigote

Trypanosoma b.gambiense,
Trypanosoma b.rhodesiense
Sleeping sickness
Stumpy metacyclic trypanosomes

Trypanosoma cruzi
Chagas’ disease
 How can Leishmania cause
hepatosplenomegaly?
Amastigotes
multiply in skin
Via blood macrophage
stream to
Taken by
Promastigotes Amastigote
Reticulo-endothelial cells Through the bite sof female
present in human viscera Phlebotomus injecting
Promastigote stage with saliva
When amastigotes enter reticulo-endothelial
cells present in liver & spleen
Hepatosplenomegaly occurs
 How can African How can American
Trypanosomes cause Trypanosomes cause
Hepatosplenomegaly? Hepatosplenomegaly?

Short stumpy metacyclic Short stumpy metacyclic

trypanosomes enter the site of trypanosomes contaminate
bite with saliva of Glossina skin abrasion by winged bug
faeces
To blood C-shaped
Polymorphic
stream Trypanosoma cruzi
trypanosomes
amastigote
To liver & spleen
Hepatosplenomegaly occurs
 Parasites causing Enlarged lymph nodes
Helminths affecting lymph nodes:
W.bancrofti
Usually affects lymph nodes
draining genitalia & lower limbs
Brugia malayi
Usually affects lymph nodes
draining legs below knees &
arms below elbows
O.volvulus
Hanging groin
containing enlarged
lymph nodes
 Enlarged lymph nodes
Protozoa affecting lymph nodes:
Leishmania infantum,
Leishmania donovani,
Leishmania chagasi
Visceral leishmaniasis
Trypanosoma b.gambiense,
Trypanosoma b.rhodesiense
Sleeping sickness
Winterbottom sign
Trypanosoma cruzi
Chagas’ disease
Toxoplasma gondii
Toxoplasmosis
 Anaemia
Decrease in number of RBCs below 4 millions / ml
Helminthic infections causing anaemia:
a- Schistosomiasis
b- Trichuriasis Iron deficiency:
c- Ancylostomiasis Due to blood loss
d- Diphyllobothriasis
Megaloblastic:
Due vit B12 deficiency
Schistosomiasis
Due to hypersplenism
Trichuriasis Blood Blood
Due to toxic products of the worm in urine in stool
 Protozoal infections associated with anaemia
• Malaria: haemolytic anaemia
due to rupture of infected red cells.
merozoites
• Babesiosis: haemolytic anaemia
due to rupture of infected red cells.

• Sleeping sickness: Polymorphic trypanosomes

hypoplastic anaemia Leishmania amastigotes

due to bone marrow affection.

• Visceral leishmaniasis:
 Mode of Infection with Schistosoma
Skin penetration by furcocercous cercaria from
contaminated canal water.
Aided by:
- Surface tension of drying
droplets of water.

- Proteolytic enzymes secreted by Proteolytic

penetration glands. enzymes

- Strong lashing movement of the tail

pressing the body of the cercaria
into the skin.
 Mode of infection with

D.latum A.duodenale
T.trichiura

ingestion of plerocercoid
larva in improperly
cooked infected salmon,
Perch or Trout fish
Skin penetration by
Ingestion of embryonated
eggs in contaminated
filariform larvae
raw vegetables and Negative geotropism
contaminated water. Positive hygrotropism
Thermotropism
 Mode of infection with

Malaria Babesiosis

Through the bite of Through the bite of

female Anopheles Hard Tick injecting
injecting sporozoite sporozoite stage
stage with saliva with saliva
 Mode of infection with

Visceral leishmaniasis Sleeping sickness

Through the bite Through the bite

of female of Glossina
Phlebotomus injecting
injecting short stumpy
Promastigote metacyclic
stage with saliva trypanosomes
 Mode of infection with

Visceral leishmaniasis Sleeping sickness

Through the bite Through the bite

of female of Glossina
Phlebotomus injecting
injecting short stumpy
Promastigote metacyclic
stage with saliva trypanosomes
 A patient presenting with Dysentery
Painful frequent evacuation of small quantities of
stool containing mucus tinged with blood.
This indicates that the large intestine is affected
Parasites causing dysentery:
1- Schistosoma mansoni.
2-Trichuris trichiura.
3- Strongyloides stercoralis
(heavy infection).
4- Entamoeba histolytica.
5- Balantidium coli.
6- Leishmania (visceral)
7- P.falciparum
 How can helminths cause Dysentery
1- Schistosoma 2- Trichuris 3- heavy infection with
mansoni trichiura Strongyloides stercoralis

Anterior part of worms Number of worms

embedded in intestinal increase and fill the
Egg pass in mucosa cause small and large intestine
stool with oedematous, hyperaemic,
mucus and fragile mucosa. stool with mucus &
blood stool with mucus & blood blood
How Entamoeba and Balantidium cause Dysentery
Balantidium Entamoeba
trophozoite trophozoite

Boring action of cilia

Histolytic enzyme

Flask-shaped Flask-shaped
ulcer ulcer
 How can Leishmania cause Dysentery?
Amastigotes
multiply in skin
Via blood macrophage
stream to
Taken by
Reticulo-endothelial cells Promastigotes
Amastigotes
present in human viscera

When amastigotes enter payer’s patches

of Intestinal mucosa:

Diarrhoea & dysentery occur

 How can P.falciparum cause Dysentery?
Knobs develop on surface of infected RBCs
Knobs are parasite antigens expressed on the surface of
infected red cells containing trophozoites and schizont
stages.
Infected RBCs adhere to receptors found on
endothelium of blood capillaries of intestine

Diminished blood supply to intestine

necrosis of intestinal wall cause

dysentery.
Normal RBC

Infected RBC
 Mode of infection with

Trichuris trichiura Strongyloides stercoralis

Ingestion of embryonated Skin penetration by

eggs in contaminated filariform larvae
raw vegetables and Negative geotropism
contaminated water. Positive hygrotropism
Thermotropism
 Mode of infection with

Entamoeba histolytica Balantidium coli

Ingestion of quadrinucleate cyst Ingestion of cyst

- In contaminated raw green vegetables
and contaminated water.
- Through flies and food handlers.

- By faeco-oral route (hand to mouth).

This is called autoinfection.
Mode of infection of

Visceral Leishmania Falciparum malaria

Through the bite of Through the bite of female

female Phlebotomus Anopheles gambia
injecting Promastigote injecting sporozoite
stage with saliva stage with saliva
Thanks for your attention!
Questions?